1 Department of Public Health, Ada West District Health Directorate, Ghana Health Service, Sege, Ghana.
2 Department of Public Health–Disease Control, College of Nursing and Midwifery, Walewale, Ghana.
3 Department of Clinical Microbiology, School of Medical Sciences, University of Technology and Applied Sciences, Navrongo, Ghana.
4 Department of Public Health, College of Health, Yamfo, Ghana.
5 Department of Public Health–Disease Control, Regional Health Directorate, Ghana Health Service, Wa, Ghana.
6 Department of Disease Control, Community Health Nursing Training College, Akim Oda, Eastern Region, Ghana.
7 Department of Public Health–Disease Control, Municipal Health Directorate, Ghana Health Service, Abuakwa, Ghana.
8 Department of Health, Allegheny County Health Department, Bureau of Clinical Services, Pittsburgh, Pennsylvania, United States of America.
* Corresponding Author: Email: oscar_vetsi@uniport.edu.ng
ORCID Details
Oscar Vetsi: https://orcid.org/0000-0002-8456-1184
Jonathan Gbene : https://orcid.org/0009-0002-6733-4737
Simon Aabalekuu: https://orcid.org/0000-0002-5580-4909
Thomas Abugbilla Atugba: https://orcid.org/0009-0002-9622-7586
Boaz Ahulu: https://orcid.org/0009-0006-8116-0496
Richard Kwaku Essien: https://orcid.org/0009-0005-5932-0193
Clement Avoka: https://orcid.org/0009-0001-4677-5341
World Journal of Advanced Research and Reviews, 2026, 32(01), 913–924
Article DOI: 10.30574/wjarr.2026.32.1.2618
Received on 07 September 2026; revised on 13 October 2026; accepted on 15 October 2026
Malaria control in Ghana's coastal savannah is constrained by outdoor biting and insecticide resistance, yet controlled evidence on environmental management is scarce. This study estimated the effect of an integrated environmental management (IEM) package on malaria parasitaemia among adults. A parallel two-arm cluster-randomised controlled trial was conducted from July to December 2024, with randomisation stratified by district: three sub-district clusters in Ada West District received the intervention, and four in North Tongu District served as controls. The six-month package combined habitat modification, habitat manipulation, targeted larviciding with Bacillus sphaericus, and community health education, while control clusters continued routine malaria control. Independent samples of 700 adults per arm were tested with an HRP2/pLDH rapid diagnostic test at baseline and end-line. The primary contrast was the difference-in-differences (DiD) in prevalence. Parasitaemia fell from 51.9% (95% CI 48.2–55.5) to 42.6% (39.0–46.3) in the intervention arm and rose from 62.3% (58.6–65.8) to 65.1% (61.5–68.6) in the control arm. The DiD was −12.1 percentage points (95% CI −19.4 to −4.9; p = 0.001), and the ratio of odds ratios was 0.61 (0.45–0.82). The effect remained statistically significant when variances were inflated for intra-cluster correlation coefficients below 0.009, but not above. The IEM package was associated with a substantial reduction in adult parasitaemia against a rising control-arm trend. Because only two district strata were randomised and the control district had recent flood exposure, the estimate is best regarded as an upper bound to be confirmed in trials with more clusters.
Malaria parasitaemia; Environmental management; Larval source management; Cluster-randomised trial; Difference-in-differences; Ghana
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Oscar Vetsi, Jonathan Gbene, Elijah Atiyire, Issah Abdul-Razak, Simon Aabalekuu, Thomas Abugbilla Atugba, Boaz Ahulu, Richard Kwaku Essien and Clement Avoka. EFFECT OF AN INTEGRATED ENVIRONMENTAL MANAGEMENT INTERVENTION ON MALARIA PARASITAEMIA PREVALENCE AMONG ADULTS IN THE ADA WEST AND NORTH TONGU DISTRICTS, GHANA: A CLUSTER-RANDOMISED CONTROLLED TRIAL WITH PRE- AND POST-INTERVENTION SURVEYS. World Journal of Advanced Research and Reviews, 2026, 32(01), 913–924. Article DOI: https://doi.org/10.30574/wjarr.2026.32.1.2618